These are antisocial and borderline personality disorders

People make decisions all the time: they form preferences, take action, and evaluate outcomes, whether rewarding or aversive. Impaired decision making is regarded as one of the neurobehavioral hallmarks of addiction. New research has found that alcoholics with certain coexisting personality disorders (PDs) have decision-making abilities that are particularly impaired.

Results are published in the October issue of Alcoholism: Clinical & Experimental Research.

"Normally, we make choices by weighing immediate benefits of different options relative to possible negative consequences in the longer term," said Geert Dom, head of treatment at the Alexian Brothers Psychiatric Centre in Boechout, Belgium. "When these abilities are impaired, people are less able to cognitively evaluate the longer-term consequences of their choices. This is reflected in real life by choices that are socially inadequate and/or related to overtly negative outcomes. Substance or polydrug use/abuse is one example."

On a neuronal level, added Dom, decision making is believed to involve multiple brain structures in the limbic region. "These brain regions are very important in the processing of emotions, motivational processes and the processing of rewards and punishments," he said. "Earlier studies have indicated that individuals with lesions in these regions lose the ability to make advantageous decisions, reflected by severe social behavioral problems and impaired performance on decision-making tasks such as the Iowa Gambling Task, which was originally designed to study decision-making in neurological patients with brain lesions."

For this study, researchers also utilized the Iowa Gambling Task among two groups: "controls" with no substance-abuse issues (n=53); and abstinent alcoholics divided into three subgroups, those without any PD (n=38), those with a cluster A or C PD (n=19), and those with certain cluster B – Antisocial and Borderline – PDs (n=23). The objective was to determine if decision-making impairments are specific to addictive disorders, or can be found within the context of other "disinhibitory" disorders.

Results indicate that decision-making impairments underlie both alcohol dependence and cluster B PDs; furthermore, those alcoholics who have a coexisting cluster B PD appear to be particularly impaired.

"These findings provide an indication that more severe impairments in decision making are clinically reflected by a more severe 'disinhibited' psychopathological profile," said Dom. "In other words, these findings may help to explain those severe problems – such as poly-substance abuse, legal and professional dysfunction, etc. – that tend to characterize cluster B alcoholics."

Dom said his study's findings also stress the importance of exploring the neurocognitive mechanisms that may underlie the development of some forms of alcohol-use disorders.

"Research findings increasingly reveal that assessment of the neurocognitive or decision-making capacities of a patient might have better prognostic validity when assessing risk of future relapse and/or a more deteriorating course of the alcohol-use disorder than any of the clinical variables that have been used up to now," he said. "Thus, assessment of decision-making capabilities might prove very valuable in identifying high-risk patients who need more and more intense treatment. Furthermore, identification of decision-making deficits in some patients may help to develop treatment interventions – both pharmacological and psychosocial – specifically designed to mediate the neurocognitive deficits underlying poor decision-making."

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Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Decision-making deficits in alcohol-dependent patients with and without comorbid personality disorder," were: Bieke De Wilde of the Alexian Brothers Psychiatric Centre; Wouter Hulstijn qnd Bernard Sabbe of the Collaborative Antwerp Psychiatry Research Institute; and Wim van den Brink of the Amsterdam Institute for Addiction Research. The study was funded by the Brothers of Charity of Belgium.

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By John M. Grohol, Psy.D. on
21 Feb 2009
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